401k Plan data: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN plan

KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 401k Plan overview

Plan Name	KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN
Plan identification number	003

KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

KEWANEE HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: KEWANEE HOSPITAL

Employer identification number (EIN): 362167767

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2017-01-01 RENEE SALISBURY JACKIE KERNAN 2018-05-14
003 2016-01-01 RENEE SALISBURY LYNN FULTON 2017-10-11
003 2015-01-01 RENEE SALISBURY LYNN FULTON 2016-10-13
003 2014-01-01 RENEE A. SALISBURY LYNN A. FULTON 2015-10-14
003 2013-01-01 RENEE A. SALISBURY LYNN A. FULTON 2014-09-26
003 2012-01-01 RENEE A. SALISBURY LYNN A. FULTON 2013-10-11
003 2011-01-01 RENEE A. SALISBURY LYNN A. FULTON 2012-10-10

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
003	2017-01-01	RENEE SALISBURY	JACKIE KERNAN	2018-05-14
003	2016-01-01	RENEE SALISBURY	LYNN FULTON	2017-10-11
003	2015-01-01	RENEE SALISBURY	LYNN FULTON	2016-10-13
003	2014-01-01	RENEE A. SALISBURY	LYNN A. FULTON	2015-10-14
003	2013-01-01	RENEE A. SALISBURY	LYNN A. FULTON	2014-09-26
003	2012-01-01	RENEE A. SALISBURY	LYNN A. FULTON	2013-10-11
003	2011-01-01	RENEE A. SALISBURY	LYNN A. FULTON	2012-10-10

Plan Statistics for KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN

401k plan membership statisitcs for KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN

Measure Date Value
2017: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 229
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 0
Number of participants with account balances 2017-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 247
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 207
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 22
Total of all active and inactive participants 2016-01-01 229
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 229
Number of participants with account balances 2016-01-01 145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 250
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 203
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 27
Total of all active and inactive participants 2015-01-01 230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 230
Number of participants with account balances 2015-01-01 152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 271
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 208
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 32
Total of all active and inactive participants 2014-01-01 240
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 240
Number of participants with account balances 2014-01-01 161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 257
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 226
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 35
Total of all active and inactive participants 2013-01-01 261
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 261
Number of participants with account balances 2013-01-01 172
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 258
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 223
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 35
Total of all active and inactive participants 2012-01-01 258
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 258
Number of participants with account balances 2012-01-01 167
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 273
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 228
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 31
Total of all active and inactive participants 2011-01-01 259
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 259
Number of participants with account balances 2011-01-01 165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2017: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	229
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	0
Number of participants with account balances	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	247
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	207
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	22
Total of all active and inactive participants	2016-01-01	229
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	229
Number of participants with account balances	2016-01-01	145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	250
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	203
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	27
Total of all active and inactive participants	2015-01-01	230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	230
Number of participants with account balances	2015-01-01	152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	271
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	208
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	32
Total of all active and inactive participants	2014-01-01	240
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	240
Number of participants with account balances	2014-01-01	161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	257
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	226
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	35
Total of all active and inactive participants	2013-01-01	261
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	261
Number of participants with account balances	2013-01-01	172
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	258
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	223
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	35
Total of all active and inactive participants	2012-01-01	258
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	258
Number of participants with account balances	2012-01-01	167
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	273
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	228
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	31
Total of all active and inactive participants	2011-01-01	259
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	259
Number of participants with account balances	2011-01-01	165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN

Measure	Date	Value
2017 : KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2017 401k financial data
Unrealized appreciation/depreciation of real estate assets	2017-07-25	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2017-07-25	$0
Total unrealized appreciation/depreciation of assets	2017-07-25	$0
Total transfer of assets to this plan	2017-07-25	$0
Total transfer of assets from this plan	2017-07-25	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-07-25	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-07-25	$0
Expenses. Interest paid	2017-07-25	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2017-07-25	$0
Total income from all sources (including contributions)	2017-07-25	$167,097
Total loss/gain on sale of assets	2017-07-25	$0
Total of all expenses incurred	2017-07-25	$2,504,181
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-07-25	$2,502,365
Expenses. Certain deemed distributions of participant loans	2017-07-25	$0
Value of total corrective distributions	2017-07-25	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-07-25	$22,000
Value of total assets at end of year	2017-07-25	$0
Value of total assets at beginning of year	2017-07-25	$2,337,084
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-07-25	$1,816
Total income from rents	2017-07-25	$0
Total interest from all sources	2017-07-25	$4,032
Total dividends received (eg from common stock, registered investment company shares)	2017-07-25	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-07-25	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2017-07-25	$0
Total dividends received from registered investment company shares (eg mutual funds)	2017-07-25	$0
Assets. Real estate other than employer real property at end of year	2017-07-25	$0
Assets. Real estate other than employer real property at beginning of year	2017-07-25	$0
Administrative expenses professional fees incurred	2017-07-25	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2017-07-25	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2017-07-25	$0
Was this plan covered by a fidelity bond	2017-07-25	Yes
Value of fidelity bond cover	2017-07-25	$500,000
If this is an individual account plan, was there a blackout period	2017-07-25	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-07-25	$0
Were there any nonexempt tranactions with any party-in-interest	2017-07-25	No
Contributions received from participants	2017-07-25	$0
Participant contributions at end of year	2017-07-25	$0
Participant contributions at beginning of year	2017-07-25	$0
Participant contributions at end of year	2017-07-25	$0
Participant contributions at beginning of year	2017-07-25	$0
Assets. Other investments not covered elsewhere at end of year	2017-07-25	$0
Assets. Other investments not covered elsewhere at beginning of year	2017-07-25	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-07-25	$22,000
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2017-07-25	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-07-25	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-07-25	$0
Assets. Loans (other than to participants) at end of year	2017-07-25	$0
Assets. Loans (other than to participants) at beginning of year	2017-07-25	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-07-25	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-07-25	$0
Other income not declared elsewhere	2017-07-25	$0
Administrative expenses (other) incurred	2017-07-25	$0
Liabilities. Value of operating payables at end of year	2017-07-25	$0
Liabilities. Value of operating payables at beginning of year	2017-07-25	$0
Total non interest bearing cash at end of year	2017-07-25	$0
Total non interest bearing cash at beginning of year	2017-07-25	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-07-25	No
Income. Non cash contributions	2017-07-25	$0
Value of net income/loss	2017-07-25	$-2,337,084
Value of net assets at end of year (total assets less liabilities)	2017-07-25	$0
Value of net assets at beginning of year (total assets less liabilities)	2017-07-25	$2,337,084
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-07-25	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-07-25	No
Were any leases to which the plan was party in default or uncollectible	2017-07-25	No
Assets. partnership/joint venture interests at end of year	2017-07-25	$0
Assets. partnership/joint venture interests at beginning of year	2017-07-25	$0
Investment advisory and management fees	2017-07-25	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-07-25	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-07-25	$2,043,474
Value of interest in pooled separate accounts at end of year	2017-07-25	$0
Value of interest in pooled separate accounts at beginning of year	2017-07-25	$0
Interest on participant loans	2017-07-25	$0
Income. Interest from loans (other than to participants)	2017-07-25	$0
Interest earned on other investments	2017-07-25	$4,032
Income. Interest from US Government securities	2017-07-25	$0
Income. Interest from corporate debt instruments	2017-07-25	$0
Value of interest in master investment trust accounts at end of year	2017-07-25	$0
Value of interest in master investment trust accounts at beginning of year	2017-07-25	$0
Value of interest in common/collective trusts at end of year	2017-07-25	$0
Value of interest in common/collective trusts at beginning of year	2017-07-25	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-07-25	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-07-25	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-07-25	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-07-25	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-07-25	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-07-25	$293,610
Expenses. Payments to insurance carriers foe the provision of benefits	2017-07-25	$0
Asset value of US Government securities at end of year	2017-07-25	$0
Asset value of US Government securities at beginning of year	2017-07-25	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-07-25	$141,065
Net investment gain/loss from pooled separate accounts	2017-07-25	$0
Net investment gain or loss from common/collective trusts	2017-07-25	$0
Net gain/loss from 103.12 investment entities	2017-07-25	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-07-25	No
Was there a failure to transmit to the plan any participant contributions	2017-07-25	No
Has the plan failed to provide any benefit when due under the plan	2017-07-25	No
Assets. Invements in employer securities at end of year	2017-07-25	$0
Assets. Invements in employer securities at beginning of year	2017-07-25	$0
Assets. Value of employer real property at end of year	2017-07-25	$0
Assets. Value of employer real property at beginning of year	2017-07-25	$0
Contributions received in cash from employer	2017-07-25	$0
Employer contributions (assets) at end of year	2017-07-25	$0
Employer contributions (assets) at beginning of year	2017-07-25	$0
Income. Dividends from preferred stock	2017-07-25	$0
Income. Dividends from common stock	2017-07-25	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-07-25	$2,502,365
Asset. Corporate debt instrument preferred debt at end of year	2017-07-25	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2017-07-25	$0
Asset. Corporate debt instrument debt (other) at end of year	2017-07-25	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2017-07-25	$0
Contract administrator fees	2017-07-25	$1,816
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-07-25	Yes
Assets. Corporate common stocks other than exployer securities at end of year	2017-07-25	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2017-07-25	$0
Liabilities. Value of benefit claims payable at end of year	2017-07-25	$0
Liabilities. Value of benefit claims payable at beginning of year	2017-07-25	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2017-07-25	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2017-07-25	$0
Did the plan have assets held for investment	2017-07-25	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-07-25	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-07-25	Yes
Aggregate proceeds on sale of assets	2017-07-25	$0
Aggregate carrying amount (costs) on sale of assets	2017-07-25	$0
Liabilities. Value of acquisition indebtedness at end of year	2017-07-25	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2017-07-25	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-07-25	Yes
Opinion of an independent qualified public accountant for this plan	2017-07-25	Disclaimer
Accountancy firm name	2017-07-25	WIPFLI LLP
Accountancy firm EIN	2017-07-25	390758449
2016 : KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets	2016-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$0
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets to this plan	2016-12-31	$0
Total transfer of assets from this plan	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Expenses. Interest paid	2016-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$144,811
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$86,587
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$86,587
Expenses. Certain deemed distributions of participant loans	2016-12-31	$0
Value of total corrective distributions	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$0
Value of total assets at end of year	2016-12-31	$2,337,084
Value of total assets at beginning of year	2016-12-31	$2,278,860
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total income from rents	2016-12-31	$0
Total interest from all sources	2016-12-31	$11,739
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$0
Assets. Real estate other than employer real property at end of year	2016-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2016-12-31	$0
Administrative expenses professional fees incurred	2016-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2016-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2016-12-31	$0
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$0
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$0
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2016-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$0
Assets. Loans (other than to participants) at end of year	2016-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$0
Other income not declared elsewhere	2016-12-31	$0
Administrative expenses (other) incurred	2016-12-31	$0
Liabilities. Value of operating payables at end of year	2016-12-31	$0
Liabilities. Value of operating payables at beginning of year	2016-12-31	$0
Total non interest bearing cash at end of year	2016-12-31	$0
Total non interest bearing cash at beginning of year	2016-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Income. Non cash contributions	2016-12-31	$0
Value of net income/loss	2016-12-31	$58,224
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,337,084
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,278,860
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Assets. partnership/joint venture interests at end of year	2016-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2016-12-31	$0
Investment advisory and management fees	2016-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$2,043,474
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,983,624
Value of interest in pooled separate accounts at end of year	2016-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$0
Interest on participant loans	2016-12-31	$0
Income. Interest from loans (other than to participants)	2016-12-31	$0
Interest earned on other investments	2016-12-31	$11,739
Income. Interest from US Government securities	2016-12-31	$0
Income. Interest from corporate debt instruments	2016-12-31	$0
Value of interest in master investment trust accounts at end of year	2016-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2016-12-31	$0
Value of interest in common/collective trusts at end of year	2016-12-31	$0
Value of interest in common/collective trusts at beginning of year	2016-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$293,610
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$295,236
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$0
Asset value of US Government securities at end of year	2016-12-31	$0
Asset value of US Government securities at beginning of year	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$133,072
Net investment gain/loss from pooled separate accounts	2016-12-31	$0
Net investment gain or loss from common/collective trusts	2016-12-31	$0
Net gain/loss from 103.12 investment entities	2016-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Assets. Invements in employer securities at end of year	2016-12-31	$0
Assets. Invements in employer securities at beginning of year	2016-12-31	$0
Assets. Value of employer real property at end of year	2016-12-31	$0
Assets. Value of employer real property at beginning of year	2016-12-31	$0
Contributions received in cash from employer	2016-12-31	$0
Employer contributions (assets) at end of year	2016-12-31	$0
Employer contributions (assets) at beginning of year	2016-12-31	$0
Income. Dividends from preferred stock	2016-12-31	$0
Income. Dividends from common stock	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$86,587
Asset. Corporate debt instrument preferred debt at end of year	2016-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2016-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2016-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2016-12-31	$0
Contract administrator fees	2016-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2016-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2016-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2016-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2016-12-31	$0
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Aggregate proceeds on sale of assets	2016-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2016-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2016-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2016-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	WIPFLI, LLP
Accountancy firm EIN	2016-12-31	390758449
2015 : KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets	2015-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$0
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	2015-12-31	$0
Total transfer of assets from this plan	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Expenses. Interest paid	2015-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$-6,651
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$229,469
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$229,469
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$2,278,860
Value of total assets at beginning of year	2015-12-31	$2,514,980
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total income from rents	2015-12-31	$0
Total interest from all sources	2015-12-31	$12,078
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$0
Assets. Real estate other than employer real property at end of year	2015-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2015-12-31	$0
Administrative expenses professional fees incurred	2015-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2015-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$0
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Assets. Loans (other than to participants) at end of year	2015-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Other income not declared elsewhere	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$0
Liabilities. Value of operating payables at end of year	2015-12-31	$0
Liabilities. Value of operating payables at beginning of year	2015-12-31	$0
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Income. Non cash contributions	2015-12-31	$0
Value of net income/loss	2015-12-31	$-236,120
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,278,860
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,514,980
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Assets. partnership/joint venture interests at end of year	2015-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2015-12-31	$0
Investment advisory and management fees	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,983,624
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,217,950
Value of interest in pooled separate accounts at end of year	2015-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$0
Interest on participant loans	2015-12-31	$0
Income. Interest from loans (other than to participants)	2015-12-31	$0
Interest earned on other investments	2015-12-31	$12,078
Income. Interest from US Government securities	2015-12-31	$0
Income. Interest from corporate debt instruments	2015-12-31	$0
Value of interest in master investment trust accounts at end of year	2015-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2015-12-31	$0
Value of interest in common/collective trusts at end of year	2015-12-31	$0
Value of interest in common/collective trusts at beginning of year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$295,236
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$297,030
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Asset value of US Government securities at end of year	2015-12-31	$0
Asset value of US Government securities at beginning of year	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-18,729
Net investment gain/loss from pooled separate accounts	2015-12-31	$0
Net investment gain or loss from common/collective trusts	2015-12-31	$0
Net gain/loss from 103.12 investment entities	2015-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Assets. Invements in employer securities at end of year	2015-12-31	$0
Assets. Invements in employer securities at beginning of year	2015-12-31	$0
Assets. Value of employer real property at end of year	2015-12-31	$0
Assets. Value of employer real property at beginning of year	2015-12-31	$0
Contributions received in cash from employer	2015-12-31	$0
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$0
Income. Dividends from preferred stock	2015-12-31	$0
Income. Dividends from common stock	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$229,469
Asset. Corporate debt instrument preferred debt at end of year	2015-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2015-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2015-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2015-12-31	$0
Contract administrator fees	2015-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2015-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2015-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2015-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2015-12-31	$0
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Aggregate proceeds on sale of assets	2015-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2015-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	WIPFLI, LLP
Accountancy firm EIN	2015-12-31	390758449
2014 : KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets	2014-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$0
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to this plan	2014-12-31	$0
Total transfer of assets from this plan	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Expenses. Interest paid	2014-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$252,633
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$409,297
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$409,297
Expenses. Certain deemed distributions of participant loans	2014-12-31	$0
Value of total corrective distributions	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$107,789
Value of total assets at end of year	2014-12-31	$2,514,980
Value of total assets at beginning of year	2014-12-31	$2,671,644
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total income from rents	2014-12-31	$0
Total interest from all sources	2014-12-31	$14,267
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$0
Assets. Real estate other than employer real property at end of year	2014-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2014-12-31	$0
Administrative expenses professional fees incurred	2014-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2014-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$107,789
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Assets. Loans (other than to participants) at end of year	2014-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$0
Administrative expenses (other) incurred	2014-12-31	$0
Liabilities. Value of operating payables at end of year	2014-12-31	$0
Liabilities. Value of operating payables at beginning of year	2014-12-31	$0
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Income. Non cash contributions	2014-12-31	$0
Value of net income/loss	2014-12-31	$-156,664
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,514,980
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,671,644
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Assets. partnership/joint venture interests at end of year	2014-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2014-12-31	$0
Investment advisory and management fees	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,217,950
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,247,568
Value of interest in pooled separate accounts at end of year	2014-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$0
Interest on participant loans	2014-12-31	$0
Income. Interest from loans (other than to participants)	2014-12-31	$0
Interest earned on other investments	2014-12-31	$14,267
Income. Interest from US Government securities	2014-12-31	$0
Income. Interest from corporate debt instruments	2014-12-31	$0
Value of interest in master investment trust accounts at end of year	2014-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2014-12-31	$0
Value of interest in common/collective trusts at end of year	2014-12-31	$0
Value of interest in common/collective trusts at beginning of year	2014-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$297,030
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$424,076
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$0
Asset value of US Government securities at end of year	2014-12-31	$0
Asset value of US Government securities at beginning of year	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$130,577
Net investment gain/loss from pooled separate accounts	2014-12-31	$0
Net investment gain or loss from common/collective trusts	2014-12-31	$0
Net gain/loss from 103.12 investment entities	2014-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Assets. Invements in employer securities at end of year	2014-12-31	$0
Assets. Invements in employer securities at beginning of year	2014-12-31	$0
Assets. Value of employer real property at end of year	2014-12-31	$0
Assets. Value of employer real property at beginning of year	2014-12-31	$0
Contributions received in cash from employer	2014-12-31	$0
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$0
Income. Dividends from preferred stock	2014-12-31	$0
Income. Dividends from common stock	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$409,297
Asset. Corporate debt instrument preferred debt at end of year	2014-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2014-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2014-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2014-12-31	$0
Contract administrator fees	2014-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2014-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2014-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2014-12-31	$0
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Aggregate proceeds on sale of assets	2014-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2014-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	WIPLI, LLP
Accountancy firm EIN	2014-12-31	390758449
2013 : KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets	2013-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$0
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total transfer of assets to this plan	2013-12-31	$0
Total transfer of assets from this plan	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Expenses. Interest paid	2013-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$747,888
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$179,256
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$179,256
Expenses. Certain deemed distributions of participant loans	2013-12-31	$0
Value of total corrective distributions	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$312,479
Value of total assets at end of year	2013-12-31	$2,671,644
Value of total assets at beginning of year	2013-12-31	$2,103,012
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total income from rents	2013-12-31	$0
Total interest from all sources	2013-12-31	$16,072
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$0
Assets. Real estate other than employer real property at end of year	2013-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2013-12-31	$0
Administrative expenses professional fees incurred	2013-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2013-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2013-12-31	$0
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$312,479
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$0
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$0
Assets. Loans (other than to participants) at end of year	2013-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$0
Administrative expenses (other) incurred	2013-12-31	$0
Liabilities. Value of operating payables at end of year	2013-12-31	$0
Liabilities. Value of operating payables at beginning of year	2013-12-31	$0
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Income. Non cash contributions	2013-12-31	$0
Value of net income/loss	2013-12-31	$568,632
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,671,644
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,103,012
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Assets. partnership/joint venture interests at end of year	2013-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2013-12-31	$0
Investment advisory and management fees	2013-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$2,247,568
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,714,938
Value of interest in pooled separate accounts at end of year	2013-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$0
Interest on participant loans	2013-12-31	$0
Income. Interest from loans (other than to participants)	2013-12-31	$0
Interest earned on other investments	2013-12-31	$0
Income. Interest from US Government securities	2013-12-31	$0
Income. Interest from corporate debt instruments	2013-12-31	$0
Value of interest in master investment trust accounts at end of year	2013-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2013-12-31	$0
Value of interest in common/collective trusts at end of year	2013-12-31	$0
Value of interest in common/collective trusts at beginning of year	2013-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$16,072
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$424,076
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$388,074
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$0
Asset value of US Government securities at end of year	2013-12-31	$0
Asset value of US Government securities at beginning of year	2013-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$419,337
Net investment gain/loss from pooled separate accounts	2013-12-31	$0
Net investment gain or loss from common/collective trusts	2013-12-31	$0
Net gain/loss from 103.12 investment entities	2013-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Assets. Invements in employer securities at end of year	2013-12-31	$0
Assets. Invements in employer securities at beginning of year	2013-12-31	$0
Assets. Value of employer real property at end of year	2013-12-31	$0
Assets. Value of employer real property at beginning of year	2013-12-31	$0
Contributions received in cash from employer	2013-12-31	$0
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$0
Income. Dividends from preferred stock	2013-12-31	$0
Income. Dividends from common stock	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$179,256
Asset. Corporate debt instrument preferred debt at end of year	2013-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2013-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2013-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2013-12-31	$0
Contract administrator fees	2013-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2013-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2013-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2013-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-12-31	$0
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Aggregate proceeds on sale of assets	2013-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2013-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2013-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	WIPFLI LLP
Accountancy firm EIN	2013-12-31	390758449
2012 : KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets	2012-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$0
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total transfer of assets to this plan	2012-12-31	$0
Total transfer of assets from this plan	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Expenses. Interest paid	2012-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$510,397
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$77,772
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$77,772
Expenses. Certain deemed distributions of participant loans	2012-12-31	$0
Value of total corrective distributions	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$289,905
Value of total assets at end of year	2012-12-31	$2,103,012
Value of total assets at beginning of year	2012-12-31	$1,670,387
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total income from rents	2012-12-31	$0
Total interest from all sources	2012-12-31	$14,116
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$0
Assets. Real estate other than employer real property at end of year	2012-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2012-12-31	$0
Administrative expenses professional fees incurred	2012-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2012-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$289,905
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$0
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Assets. Loans (other than to participants) at end of year	2012-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$0
Other income not declared elsewhere	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$0
Liabilities. Value of operating payables at end of year	2012-12-31	$0
Liabilities. Value of operating payables at beginning of year	2012-12-31	$0
Total non interest bearing cash at end of year	2012-12-31	$0
Total non interest bearing cash at beginning of year	2012-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Income. Non cash contributions	2012-12-31	$0
Value of net income/loss	2012-12-31	$432,625
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,103,012
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,670,387
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Assets. partnership/joint venture interests at end of year	2012-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2012-12-31	$0
Investment advisory and management fees	2012-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,714,938
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$1,335,062
Value of interest in pooled separate accounts at end of year	2012-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$0
Interest on participant loans	2012-12-31	$0
Income. Interest from loans (other than to participants)	2012-12-31	$0
Interest earned on other investments	2012-12-31	$0
Income. Interest from US Government securities	2012-12-31	$0
Income. Interest from corporate debt instruments	2012-12-31	$0
Value of interest in master investment trust accounts at end of year	2012-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2012-12-31	$0
Value of interest in common/collective trusts at end of year	2012-12-31	$0
Value of interest in common/collective trusts at beginning of year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$14,116
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$388,074
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$335,325
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$0
Asset value of US Government securities at end of year	2012-12-31	$0
Asset value of US Government securities at beginning of year	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$206,376
Net investment gain/loss from pooled separate accounts	2012-12-31	$0
Net investment gain or loss from common/collective trusts	2012-12-31	$0
Net gain/loss from 103.12 investment entities	2012-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Assets. Invements in employer securities at end of year	2012-12-31	$0
Assets. Invements in employer securities at beginning of year	2012-12-31	$0
Assets. Value of employer real property at end of year	2012-12-31	$0
Assets. Value of employer real property at beginning of year	2012-12-31	$0
Contributions received in cash from employer	2012-12-31	$0
Employer contributions (assets) at end of year	2012-12-31	$0
Employer contributions (assets) at beginning of year	2012-12-31	$0
Income. Dividends from preferred stock	2012-12-31	$0
Income. Dividends from common stock	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$77,772
Asset. Corporate debt instrument preferred debt at end of year	2012-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2012-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2012-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2012-12-31	$0
Contract administrator fees	2012-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2012-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2012-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2012-12-31	$0
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Aggregate proceeds on sale of assets	2012-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2012-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2012-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	WIPFLI LLP
Accountancy firm EIN	2012-12-31	390758449
2011 : KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets	2011-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$0
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$1,658,130
Total transfer of assets from this plan	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Expenses. Interest paid	2011-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$249,005
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$236,748
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$236,748
Expenses. Certain deemed distributions of participant loans	2011-12-31	$0
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$263,609
Value of total assets at end of year	2011-12-31	$1,670,387
Value of total assets at beginning of year	2011-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total income from rents	2011-12-31	$0
Total interest from all sources	2011-12-31	$16,166
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$0
Assets. Real estate other than employer real property at end of year	2011-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2011-12-31	$0
Administrative expenses professional fees incurred	2011-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2011-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$263,609
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$0
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$0
Assets. Loans (other than to participants) at end of year	2011-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$0
Liabilities. Value of operating payables at end of year	2011-12-31	$0
Liabilities. Value of operating payables at beginning of year	2011-12-31	$0
Total non interest bearing cash at end of year	2011-12-31	$0
Total non interest bearing cash at beginning of year	2011-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Income. Non cash contributions	2011-12-31	$0
Value of net income/loss	2011-12-31	$12,257
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,670,387
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Assets. partnership/joint venture interests at end of year	2011-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2011-12-31	$0
Investment advisory and management fees	2011-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$1,335,062
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$0
Value of interest in pooled separate accounts at end of year	2011-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$0
Interest on participant loans	2011-12-31	$0
Income. Interest from loans (other than to participants)	2011-12-31	$0
Interest earned on other investments	2011-12-31	$0
Income. Interest from US Government securities	2011-12-31	$0
Income. Interest from corporate debt instruments	2011-12-31	$0
Value of interest in master investment trust accounts at end of year	2011-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2011-12-31	$0
Value of interest in common/collective trusts at end of year	2011-12-31	$0
Value of interest in common/collective trusts at beginning of year	2011-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$16,166
Assets. Value of investments in 103.12 investment entities at end of year	2011-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$335,325
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$0
Asset value of US Government securities at end of year	2011-12-31	$0
Asset value of US Government securities at beginning of year	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-30,770
Net investment gain/loss from pooled separate accounts	2011-12-31	$0
Net investment gain or loss from common/collective trusts	2011-12-31	$0
Net gain/loss from 103.12 investment entities	2011-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Assets. Invements in employer securities at end of year	2011-12-31	$0
Assets. Invements in employer securities at beginning of year	2011-12-31	$0
Assets. Value of employer real property at end of year	2011-12-31	$0
Assets. Value of employer real property at beginning of year	2011-12-31	$0
Contributions received in cash from employer	2011-12-31	$0
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$0
Income. Dividends from preferred stock	2011-12-31	$0
Income. Dividends from common stock	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$236,748
Asset. Corporate debt instrument preferred debt at end of year	2011-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2011-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2011-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2011-12-31	$0
Contract administrator fees	2011-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2011-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2011-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2011-12-31	$0
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Aggregate proceeds on sale of assets	2011-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2011-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2011-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	WIPFLI LLP
Accountancy firm EIN	2011-12-31	390758449

Form 5500 Responses for KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN

2017: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	Yes
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G91664

Policy instance

Insurance contract or identification number	G91664
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-07-25
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G91664

Policy instance

Insurance contract or identification number	G91664
Number of Individuals Covered	152
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,349
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	2349
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	GARDNER & WHITE

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G91664

Policy instance

Insurance contract or identification number	G91664
Number of Individuals Covered	161
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,305
Total amount of fees paid to insurance company	USD $2,621
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,305
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	GARDNER & WHITE

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G91664

Policy instance

Insurance contract or identification number	G91664
Number of Individuals Covered	172
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,824
Total amount of fees paid to insurance company	USD $2,452
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,408
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	GARDNER AND WHITE CORPORATION

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G91664

Policy instance

Insurance contract or identification number	G91664
Number of Individuals Covered	167
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,407
Total amount of fees paid to insurance company	USD $1,963
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,407
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	GARDNER & WHITE

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G91664

Policy instance

Insurance contract or identification number	G91664
Number of Individuals Covered	165
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,132
Total amount of fees paid to insurance company	USD $1,718
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	KEWANEE HOSPITAL
Employer identification number (EIN):	362167767
NAIC Classification:	622000
NAIC Description:	Hospitals